Provider Demographics
NPI:1821873761
Name:IMES, PATRICK JAVON
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAVON
Last Name:IMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5334 CLAY TER NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6642
Mailing Address - Country:US
Mailing Address - Phone:202-602-9706
Mailing Address - Fax:
Practice Address - Street 1:1235 SHEPHERD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5611
Practice Address - Country:US
Practice Address - Phone:202-652-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant